Devices for performing minimally invasive surgery having rotating multiport access

ABSTRACT

An access device for surgical procedures includes a multiport end cap including a plurality of separate access ports for accommodating introduction of individual surgical instruments into the body of a patient. The access ports extend in a proximal direction. The end cap includes a distally extending seal ring. A bottom body has a distally extending tubular body with an access channel defined therethrough for accommodating surgical instruments from the access ports into the body of a patient. The bottom body includes a plurality of circumferentially spaced apart teeth, wherein the seal ring of the end cap is received inside and seals against a proximal rim of the bottom body. The end cap includes at least one flexible tab with distal teeth thereon configured to engage and disengage the teeth of the bottom body to selectively permit or prevent relative axial rotation of the multiport end cap.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The subject invention is directed to surgical access devices, and moreparticularly, to multi-port access devices for minimally invasivesurgical procedures.

2. Description of Related Art

Laparoscopic or “minimally invasive” surgical techniques are becomingcommonplace in the performance of procedures such as cholecystectomies,appendectomies, hernia repair and nephrectomies. Benefits of suchprocedures include reduced trauma to the patient, reduced opportunityfor infection, and decreased recovery time. Such procedures commonlyinvolve filling or “insufflating” the abdominal (peritoneal) cavity witha pressurized fluid, such as carbon dioxide, to create what is referredto as a pneumoperitoneum.

The insufflation can be carried out by a surgical access device equippedto deliver insufflation fluid, or by a separate insufflation device,such as an insufflation (veress) needle. CONMED Corporation of Utica,N.Y., USA has developed unique surgical access devices that permit readyaccess to an insufflated surgical cavity without the need forconventional mechanical seals, and it has developed related gas deliverysystems for providing sufficient pressure and flow rates to such accessdevices, as described in whole or in part in U.S. Pat. No. 7,854,724 andU.S. Pat. No. 8,795,223, the disclosures of which are both hereinincorporated by reference in their entireties.

During typical laparoscopic procedures, a surgeon makes three to foursmall incisions, usually no larger than about twelve millimeters each.Typically the surgical access device is inserted into an incision usinga separate inserter or obturator placed therein. Following insertion,the inserter is removed, and the trocar allows access for instruments tobe inserted into the abdominal cavity.

A variety of larger access devices are also known in the art foraccessing a surgical site through a single relatively large incision toperform minimally invasive procedures, rather than through multiplesmall incisions. Examples of such devices are disclosed in U.S. PatentApplication Publication No. 2013/0012782, the disclosure of which isherein incorporated by reference in its entirety.

Trans-anal minimally invasive surgery (TAMIS) is a specialized minimallyinvasive approach to removing benign polyps and some cancerous tumorswithin the rectum and lower sigmoid colon. The benefit of TAMIS is thatit is considered an organ-sparing procedure, and is performed entirelythrough the body's natural opening, requiring no skin incisions to gainaccess to a polyp or tumor. This scar-free recovery provides a quickreturn to normal bowel function. Unlike traditional surgery where amajor portion of the large intestine is removed, with TAMIS the surgeonwill precisely remove the diseased tissue, leaving the rest of thenatural bowel lumen intact to function normally. Traditional surgeryoften requires a large incision and a hospital stay ranging from a fewdays to more than a week. A TAMIS procedure may only require anovernight stay in the hospital or can be performed as an outpatientprocedure, often permitting patients an immediate return to an activelifestyle. TATMe (Trans-anal Total Mesorectal Excision) is a moresignificant trans-anal procedure.

It would be beneficial to provide a single incision access device havingmultiple ports with a variety of different port sizes to give a surgeonmore options for instrument introduction during a laparoscopic surgicalprocedure. It would also be beneficial to provide an access devicehaving multiple ports with a variety of different port sizes thatenables ready access to natural orifices for performing trans-analminimally invasive surgical procedures or the like.

SUMMARY OF THE INVENTION

An access device for surgical procedures includes a multiport end capincluding a plurality of separate access ports for accommodatingintroduction of individual surgical instruments into a body of apatient. The access ports extend in a proximal direction. The end capincludes a distally extending seal ring. A bottom body has a distallyextending tubular body with an access channel defined therethrough foraccommodating surgical instruments from the access ports into the bodyof a patient. The bottom body includes a plurality of circumferentiallyspaced apart teeth, wherein the seal ring of the end cap is receivedinside and seals against a proximal rim of the bottom body. The end capincludes at least one flexible tab with distal teeth thereon configuredto engage and disengage the teeth of the bottom body to selectivelypermit or prevent relative axial rotation of the multiport end cap.

The teeth of each of the at least one flexible tabs can extend radiallyinwardly, wherein the teeth of the bottom body extend radially outward.Each of the at least one flexible tabs can include a proximallyextending manipulation member and a compliant hinge member between themanipulation member and the distal teeth of the flexible tab. There canbe two circumferentially opposed flexible tabs configured so thatsqueezing the manipulation members together releases the teeth of theflexible tabs to allow rotation of the end cap relative to the bottombody.

An elastomeric seal ring can form a seal between the seal ring of theend cap and the proximal rim of the bottom body to provide sealing evenduring relative rotation of the end cap and bottom body. The elastomericseal can be seated in a circumferential channel defined in at least oneof the seal ring and the proximal rim.

The bottom body can include an insufflation gas inlet in fluidcommunication with the access channel. The insufflation gas inlet can beconfigured to receive a tube set with one or more lumens. The accessports can be configured to form mechanical seals for insufflation gasfor when instruments are inserted through the access ports and whenthere are no instruments inserted through the access ports.

There can be three access ports extending proximally from the end cap,evenly spaced circumferentially about the end cap. Each access port canextend from a respective planar facet of the end cap. Each access portcan extend normal from the respective facet of the end cap. Therespective facets can meet at facet junctures, wherein the facetjunctures meet each other at an apex of the end cap. Each facet can beangled at an angle a from a circumferential plane of the end cap. Theangle a can be larger than 0° and less than or equal to 60°.

The tubular body can be configured for introduction through a body lumenor through a single incision formed in the wall of the body of apatient. The tubular body can be configured for trans-anal introduction.The at least one flexible tab can be integral with the end cap. The endcap can be configured for complete 360° axial rotation relative to thebottom body. The bottom body can include a latching surface proximal tothe teeth thereof, wherein the at least one flexible tab is configuredto latch with the latching surface even during relative axial rotationof the end cap and the bottom body to prevent axial displacement of theend cap relative to the bottom body. The tubular body can be mounted toa main ring portion of the bottom body, wherein the tubular body is of aless rigid material than that of the main ring portion. The end cap caninclude a radially protruding stopper rim that abuts a proximal mostsurface of bottom body.

At least one of the access ports can include a surgical port assemblyhaving a surgical port body extending from an upper surface of the endcap and defining an access channel therethrough. A cap can be mounted toa proximal end of the surgical port body and can open into the accesschannel of the surgical port body. A main seal can have a base fixedbetween the cap and the surgical port body to suspend the main sealacross the access channel of the surgical port body to providemechanical sealing against surgical instruments extending through theaccess channel of the surgical port body. A duck bill seal can beincluded distal from the main seal within the access channel of thesurgical port body. The duck bill seal can include a base fixed betweenthe cap and the surgical port body to provide mechanical sealing againstsurgical instruments extending through the access channel of thesurgical port body. A seal guard can be seated in an unfixed mannerbetween the cap and the main seal within the access channel of thesurgical port body, wherein the seal guard extends across the accesschannel of the surgical port body and is configured to move relative tothe cap and the surgical port body to accommodate movement of surgicalinstruments extending through the access channel of the surgical portbody, to provide protection for the main seal and the duck bill seal,and to prevent inversion of the main seal and/or the duck bill seal. Theseal guard can define a frustoconical section defined by a plurality ofspaced apart deflectable panels separated by a plurality of access slitsthrough the frustoconical section for passage of surgical instrumentsthrough the seal guard.

These and other features of the systems and methods of the subjectdisclosure will become more readily apparent to those skilled in the artfrom the following detailed description of the preferred embodimentstaken in conjunction with the drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

So that those skilled in the art to which the subject disclosureappertains will readily understand how to make and use the devices andmethods of the subject disclosure without undue experimentation,preferred embodiments thereof will be described in detail herein belowwith reference to certain figures, wherein:

FIG. 1 is a perspective view of an exemplary embodiment of an accessdevice constructed in accordance with the present disclosure, showingthe flexible tab and teeth configured to selectively permit or preventrelative axial rotation of the multiport end cap;

FIG. 2 is an exploded perspective view of the access device of FIG. 1,showing the multiport end cap removed from the bottom body;

FIG. 3 is a plan view of the access device of FIG. 1, showing the twoopposed flexible tabs viewed looking distally;

FIG. 4 is a plan view of the access device of FIG. 1, showing the twoopposed flexible tabs viewed looking proximally;

FIG. 5 is a side elevation view of the access device of FIG. 1, showinga connection port for a tube set;

FIG. 6 is a cross-sectional side elevation view of the access device ofFIG. 1, showing the sealing ring of the end cap sealing against theproximal rim of the bottom body;

FIG. 7 is a cross-sectional side elevation view of the access device ofFIG. 1, showing the flexible tabs engaging the teeth of the bottom body;

FIG. 8A is a cross-sectional side elevation view of a portion of theaccess device of FIG. 1, showing a pivoting hinge instead of complianthinge for the flexible tabs;

FIG. 8B is a perspective view of a portion of the access device of FIG.1, showing the end cap;

FIG. 9 is a side elevation view of the end cap of FIG. 8, showing theangle of the facet junctures of the end cap;

FIG. 10 is a plan view of the end cap of FIG. 8, showing the teeth ofthe flexible tabs;

FIG. 11 is a plan view of a portion of the end cap of FIG. 8, showingthe teeth of one of the flexible tabs;

FIG. 12 is a side elevation view of one of the access ports of the endcap of FIG. 8, showing the bellow;

FIG. 13 is a cross-sectional side elevation view of the access port ofFIG. 12, showing the cross-section of the bellow;

FIG. 14 is a side elevation view of another embodiment of an end capconstructed in accordance with the present disclosure, showing bellowswith accordion cross-sections;

FIG. 15 is a cross-sectional side elevation view of the end cap of FIG.14, showing the cross-section of one of the bellows;

FIG. 16 is a perspective view of another exemplary embodiment of an endcap constructed in accordance with the present disclosure, showing twoflexible supports, one including a single bellow and one including adouble bellow;

FIG. 17 is an exploded perspective view of the end cap of FIG. 16,showing rigid bellow supports with support ribs to inhibit inversion ofthe bellows;

FIG. 18 is a perspective view of the double bellow of FIG. 16;

FIG. 19 is a perspective view of another exemplary embodiment of an endcap constructed in accordance with the present disclosure, showing asingle flexible support with three bellows;

FIG. 20 is an exploded perspective view of the end cap of FIG. 19,showing a rigid bellow support with support ribs to inhibit inversion ofthe bellows;

FIG. 21 is a perspective view of the triple bellow of FIG. 19;

FIG. 22 is a perspective view of another exemplary embodiment of an endcap constructed in accordance with the present invention, showing aflexible body that includes a flexible foam material;

FIG. 23 is an exploded perspective view of the end cap of FIG. 22,showing the rigid body separated from the flexible foam support;

FIG. 24 is a perspective view of another exemplary embodiment of an endcap constructed in accordance with the present invention;

FIG. 25 is an exploded perspective view of the end cap of FIG. 24,showing the access ports separated from the flexible foam support;

FIG. 26 is a plan view of the end cap of FIG. 24, showing the flexibletabs;

FIG. 27 is a cross-sectional side elevation view of the end cap of FIG.24, showing the attachment of one of the access ports to the flexiblefoam support;

FIG. 28 is a cross-sectional side elevation view of a portion of the endcap of FIG. 24, showing the gripping rims of one of the access portsgripping the flexible support;

FIG. 29 is an exploded perspective view of one of the access portsconstructed in accordance with an exemplary embodiment, showing the sealguard;

FIG. 30 is a side elevation view of the access port of FIG. 29, showingthe cap mounted on the proximal end of the surgical port body;

FIG. 31 is a cross-sectional side elevation view of a portion of theaccess port of FIG. 29, showing the bases of the main and duck billseals fixed between the cap and the surgical port body with the base ofthe seal guard floating unfixed relative to the cap and surgical portbody;

FIG. 32 is a side elevation view of the seal guard of FIG. 29, showingthe access slits;

FIG. 33 is distal end view of the seal guard of FIG. 32, showing thecircumferential spacing of the access slits; and

FIG. 34 is a schematic view of the access device of FIG. 1, showingaccess ports 40 that vary in size relative to one another.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Reference will now be made to the drawings wherein like referencenumerals identify similar structural features or aspects of the subjectdisclosure. For purposes of explanation and illustration, and notlimitation, a partial view of an exemplary embodiment of an accessdevice in accordance with the disclosure is shown in FIG. 1 and isdesignated generally by reference character 10. Other embodiments ofaccess devices in accordance with the disclosure, or aspects thereof,are provided in FIGS. 2-34, as will be described. The systems andmethods described herein can be used for single incision/natural orificesurgical access, such as for trans-anal minimally invasive surgicalprocedures, with multiple ports. Commonly assigned U.S. PatentApplication Publication Nos. 2016/0287817 and 2017/0056064 areincorporated by reference herein in their entireties. U.S. PatentApplication Publication No. 2017/0050011 is incorporated by referenceherein in its entirety.

The access device 10 for surgical procedures includes a multiport endcap 20 and a bottom body 30. The end cap includes a plurality ofseparate access ports 40 for accommodating introduction of individualsurgical instruments into a body of a patient. The access ports 40extend in a proximal direction, i.e., upwards as oriented in FIG. 1. Thebottom body 30 has a distally extending, i.e. downward extending asoriented in FIG. 1, tubular body 8 with an access channel 9, shown inFIGS. 6-7, defined therethrough for accommodating surgical instrumentsfrom the access ports 40 into the body of a patient. The tubular body 8is mounted to a main ring portion 6 of the bottom body 30. The tubularbody 8 is of a less rigid material than that of the main ring portion 6.The tubular body 8 is configured for introduction into a patient's body, e.g., for trans-anal introduction, or through a single incision formedin the wall of the abdominal cavity of a patient. The bottom body 30includes suture tie downs 22, which are identified in FIG. 4. After thetubular body 8 of bottom body 30 is inserted into a body cavity orincision, the end cap 20 can be attached to the bottom body 30 toprovide gas seal functionality.

The bottom body 30 includes an insufflation gas inlet 14 in fluidcommunication with the access channel 9 through tubular body 8. Theinsufflation gas inlet 14 shown in FIG. 5 is configured to receive atube set with one or more lumens, e.g., a double lumen tube set, howeverthose skilled in the art will readily appreciate that any other suitabletype of inlet can be used without departing from the scope of thisdisclosure. The access ports 40 are configured to form mechanical sealsfor insufflation gas for when instruments are inserted through theaccess ports 40, and when there are no instruments inserted through theaccess ports 40.

With reference now to FIG. 2, the end cap 20 includes a distallyextending seal ring 2. The seal ring 2 of the end cap 20 is receivedinside and seals against a proximal rim 3 of the bottom body 30. The endcap 20 includes a radially protruding stopper rim 5 that abuts aproximal most surface 19 of bottom body 30. An elastomeric seal ring 12forms a seal between the seal ring 2 of the end cap 20 and the proximalrim 3 of the bottom body 30 to provide sealing even during relativerotation of the end cap 20 and bottom body 30 about the longitudinalaxis A. The elastomeric seal 12 is seated in a circumferential channel13 defined in the seal ring 2.

The bottom body 30 includes a plurality of circumferentially spacedapart teeth 18 on the outside of the proximal rim 3. The end cap 20includes an opposed pair of flexible tabs 16, shown in FIGS. 3-4, withdistal teeth 32 thereon that extend radially inward, as shown in FIGS.10 and 11, configured to engage and disengage the radially outwardlyextending teeth 18 of the bottom body 30 to selectively permit orprevent relative axial rotation of the multiport end cap 20 around thelongitudinal axis A.

With reference now to FIGS. 7 and 8A, each of the flexible tabs 16includes a proximally extending manipulation member 17 and a complianthinge member 24 between the manipulation member and the distal teeth 32of the flexible tab 16. In FIG. 7, hinge member 24 is shown as acompliant hinge member, however it can also be a pivoting hinge member24 as shown in FIG. 8A. The flexible tabs 16 are integral with the endcap 20, and are connected to the end cap 20 by the complaint hingemembers 24. Since there are there are two circumferentially opposedflexible tabs 16, squeezing the manipulation members 17 together, i.e.,radially inward towards one another, releases the teeth 32 of theflexible tabs 16 from the teeth 18 of the bottom body 30 to allowrotation of the end cap 20 relative to the bottom body 30 around thelongitudinal axis A. The end cap 20 is configured for complete 360°axial rotation relative to the bottom body 30. Releasing the flexibletabs 16 re-engages the teeth 18 and 32 to prevent further rotation. Thebottom body 30 includes a latching surface 23, labeled in FIG. 8A,proximal to the teeth 18 thereof. The flexible tabs 16 latch with thelatching surface 23 to prevent axial movement of the end cap away fromthe bottom body when the teeth 18 and 32 are engaged, and can even staylatched when the teeth 18 and 32 are disengaged during relative axialrotation of the end cap 20 and the bottom body 30 to prevent axialdisplacement of the end cap 20 relative to the bottom body 30 duringrotation. Optional feedback member 11 cams against the cam 7 to increaseforce feedback as a user squeezes manipulation members 17 to preventover squeezing to keep latching surface 23 engaged to the teeth 32 whenrotating end cap 20 without axially removing it from bottom body 30. Theproximal rim 3 is sandwiched between the seal ring 2 and teeth 32 of endcap 20, as shown in the cross-section of FIG. 7.

With reference now to FIG. 8B, there are three access ports 40 extendingproximally from the end cap 20. As shown in FIGS. 3 and 10, the accessports 40 are evenly spaced circumferentially about the end cap 20, andall three access ports 40 can be of a uniform size with one another, orcan vary in size. Each access port 40 includes a rigid cannula body 42and a cannula cap 44 housing a seal assembly 50, shown in FIG. 6, forsealing against surgical instruments passing through the respectiveaccess port 40. Each cannula body 42 is permanently attached in an airtight manner to a bellow 4, e.g. of an elastomeric material, which is inturn permanently attached in an air tight manner to the respective facet25 of end cap 20, e.g., by adhesive, ultrasound welding, over molding,or any other suitable joining process). The flexibility of bellow 4allows for relative movement of the rigid cannula bodies 42 with respectto one another to provide flexibility and movement for surgical devicesinserted through access ports 40.

Each access port 40 extends from a respective planar facet 25 of the endcap 40. Each access port 40 extends normal from the respective facet 25of the end cap 20. The respective facets 25 meet at facet junctures 27,wherein the facet junctures meet each other at an apex 29 of the end cap20. As shown in FIG. 9, each facet 25 is angled at an angle a from acircumferential plane of the end cap 20, e.g., relative to a planeparallel to rim 5. The angle a is larger than 0° and less than or equalto 60°.

With reference now to FIG. 12, an access port with another embodiment ofa bellow 52 is shown, wherein the base 53 of the bellow 52 is circular.As shown in FIG. 13, bellow 52 forms a flexible support with a singlesigmoidal cross-section that positions a distal end 51 of the at leastone access port 40 within the multiport end cap, represented in FIG. 13by the dashed line, and as shown in the cross sections of FIGS. 6 and 7.The flexible supports, e.g., including bellows 52, described herein caninclude at least one of a rubber material, a rubber-like material,and/or a VersaFlex material available from VersaFlex Incorporated ofKansas City, Kans.

Referring now to FIG. 14, another exemplary embodiment of an accessdevice 100 for surgical procedures includes a multiport end cap 120having a rigid body 102 with flexible supports 154 sealingly mounted tothe rigid body 102 with a plurality of separate access ports 40 foraccommodating introduction of individual surgical instruments into abody of a patient, much as described above with respect to access device10. Each of the access ports 40 is sealingly attached to a respectiveone of the flexible supports 154 and extends in a proximal directiontherefrom, i.e., in an upwards direction as oriented in FIG. 14. Theflexible supports 154 are of a material more flexible than those of therigid body 102 and access ports 40 to provide for relative angularmovement of the access ports 40 to provide flexibility for positioningsurgical instruments introduced through the access ports 40. Each of theflexible supports 154 includes a flexible bellow with an accordioncross-section, as shown in FIG. 15, which spaces a distal end 55 of therespective access port 40 proximally from the multiport end cap 20.

With reference now to FIG. 16, another exemplary embodiment of an endcap 60 is shown. Whereas the bellows 52 and 154 in FIGS. 12-15 have aperimeter shape about the respective access ports that is round, in endcap 60, the bellows 66 have diamond shaped perimeters around therespective access ports 40. As shown in FIG. 17, the rigid body of endcap 60 includes a rigid top body 62 and a two rigid bellow supports 72and 74. The rigid top body 62 and the rigid bellow supports 72 and 74compress an outer peripheral edge 67 of the flexible supports 64 and 65therebetween axially, e.g., by ultrasound welding, adhesive, or anyother suitable joining technique, to form a sealing engagement betweenthe rigid body of the end cap 60 and the flexible supports 64 and 65.The rigid bellow supports 72 and 74 each include a respective supportrib 76 and 78 extending proximally from the rigid bellow support 72 and74 into the respective bellow 66 to inhibit inversion of the bellow 66during instrument insertion into the access port 40.

Each access port 40 can include a compression ring 68 engaged to thedistal end 51 of the access port 40. An inner edge 69 of the flexiblesupports 64 and 65 compressed between the respective access port 40 andthe compression ring 68 to form a sealing engagement between the accessports 40 and the flexible supports 64 and 65. Each paired access port 40and compression ring 68 include an axially opposed pair of respectivegripping rims 71 and 73 with a portion of the respective flexiblesupport 64 and 65 gripped between the gripping rims 71 and 73. Eachflexible support has a respective receptacle groove 75 defined thereinfor engaging each of the gripping rims 71 and 73. Each of the accessports 40 includes a respective seal, much like seal assembly 50described above, configured to seal against gas flow when no surgicalinstrument is introduced therethrough, and to seal around surgicalinstruments introduced therethrough.

As with end cap 20 described above, end cap 60 includes three accessports 40 extending proximally from the end cap 60. One of the accessports 40 connects to the rigid body of end cap 60 through the flexiblesupport 65, wherein the flexible support 65 has a single bellow 66. Theremaining two access ports 40 connect to the rigid body of end cap 60through the flexible support 64, wherein the flexible support 64 has twobellows 66, i.e., a double bellow, as shown in FIG. 18, one for each ofthe two access ports 40.

With reference again to FIG. 17, the rigid bellow support 72 of therigid support includes two respective support ribs 76 extendingproximally from the rigid support 72 into each one of the two bellows66, respectively, to inhibit inversion of the two bellows 66 duringinstrument insertion into the access port 40. The rigid bellow support74 includes a single support rib 76 extending proximally from the rigidsupport 74 into the respective bellow 66 for the same purpose.

Referring now to FIG. 19, another exemplary embodiment of an end cap 80much like end caps 20 and 60 described above is shown with diamondshaped bellows 66. The three access ports 40 connect to the rigid bodyof end cap 80 through the flexible support 84, wherein the flexiblesupport 84 has three bellows 66, i.e., a triple bellow as shown in FIG.21, one for each of the three access ports 40. As shown in FIG. 20, therigid body of end cap 80 includes a rigid top body 82 and a single rigidbellow support 86. The rigid top body 82 and the rigid bellow support 86compress an outer peripheral edge 87 of the flexible support 84therebetween to form a sealing engagement between the rigid body of theend cap 80 and the flexible support 84. Three respective support ribs 88extending proximally from the rigid support 86 into each one of thethree bellows 66, respectively, to inhibit inversion of the bellows 66during instrument insertion into the access ports 40.

With reference now to FIG. 22, another exemplary embodiment of an accessdevice 200 is shown for surgical procedures. Access device 200 includesa multiport end cap 220 having a rigid body 204 with a flexible support206 sealingly mounted to the rigid body 204 with a plurality of separateaccess ports 40 as described above for accommodating introduction ofindividual surgical instruments into a body of a patient.

A bottom body 230 is included in the access device 200, having adistally extending tubular body 202 with an access channel definedtherethrough for accommodating surgical instruments from the accessports 40 into the body of a patient as in embodiments described above.The bottom body 230 includes a connection port 203 for connecting a tubeset with one or more lumens in fluid communication with the accesschannel much as described above with respect to access device 10. Theaccess ports 40 are configured to form mechanical seals for insufflationgas for when instruments are inserted through the access ports 40, andwhen there are no instruments inserted though the access ports 40. Thetubular body 202 is mounted to a main ring portion 207 of the bottombody 230, and wherein the tubular body 202 is of a less rigid materialthan that of the main ring portion 207. The tubular body 202 isconfigured for introduction through a natural orifice of a body lumen orthrough a single incision formed in the wall of the abdominal cavity ofa patient, for trans-anal introduction, or any other suitable mode ofintroduction.

As in embodiments described above, the end cap 220 is configured forcomplete 360° axial rotation relative to the bottom body 230 aboutlongitudinal axis A. The rigid body includes at least one flexible tab216 configured to engage and disengage the bottom body 230 toselectively permit or prevent relative axial rotation of the multiportend cap 220 and bottom body 230 as described above with respect toaccess device 10. Each of the access ports 40 includes a respective sealassembly as described with respect to embodiments above.

The access ports 40 are sealingly attached to the flexible support 206and extend in a proximal direction therefrom, i.e. upwards as orientedin FIG. 22. The flexible support 206 is of a material more flexibleand/or stretchable than those of the rigid body 204 and access ports 40to provide for relative angular movement of the access ports 40 toprovide flexibility for positioning surgical instruments introducedthrough the access ports.

With reference now to FIG. 23, the flexible support 206 includes aflexible, closed-cell foam material for providing sealing to prevent gasflow therethrough; however it is also contemplated that an open-cellfoam material can be used with an air tight coating. It is alsocontemplated that the foam material can include at least one of a rubbermaterial, a rubber-like material, a VersaFlex material available fromVersaFlex Incorporated of Kansas City, Kans., and/or a foam materialmade from a gel or gel-like material. The access ports 40 are mounted toa distal surface of the flexible support 206, i.e. the bottom surface offlexible support 206 as oriented in FIG. 23, and extend proximallythrough respective bores 209 in the flexible support 206 to extendproximally from the flexible support 206. The rigid body 204 defines acomplete circumferential ring wherein the flexible support 206 ismounted within and spans the circumferential ring forming a completecircumferential seal between the rigid body 204 and the flexible support206. The flexible support 206 is adhered, ultrasonic welded, clamped orjoined by any other suitable joining technique to an inward facingsurface 211 of the circumferential ring to form a gas tight seal betweenthe flexible support 206 and the rigid body 204.

As with embodiments described above, there are three access ports 40extending proximally from the end cap 220, evenly spacedcircumferentially about the end cap 220, and uniform in size with oneanother, however it is also contemplated that in an end cap can haveports of sizes that differ from one another as shown schematically inFIG. 34. Each access port 40 extends from a respective planar facet 225of the flexible support 206. Each access port 40 extends normal from therespective facet 225 of the flexible support. The respective facets 225meet at facet junctures 227, wherein the facet junctures 227 meet eachother at an apex 229 of the flexible support 206. Each facet 225 isangled at an angle a from a circumferential plane of the end cap 220.The angle a is not labeled in FIG. 23, but see angle α labeled in FIG. 9as described above. The angle a is larger than 0° and less than or equalto 60°. It is also contemplated that the flexible support 206 can beflat, e.g. where angle α is equal to 0°.

With reference now to FIG. 24, another exemplary embodiment of an accessdevice 300 is shown, including a flexible support 306 as described abovewith respect to access device 200.

As shown in FIG. 25, the circumferential ring of rigid body 304 includesa proximal ring portion 313 and a distal ring portion 314. As shown inFIGS. 26-27, the flexible support 306 is squeezed between the proximaland distal ring portions 313 and 314. The flexible support 306 defines arespective ring groove 315 (labeled in FIGS. 25 and 28) in its proximaland distal surfaces for receiving circumferential rims of the proximaland distal ring portions 313 and 314. The proximal and distal portions313 and 314 can be sealingly joined to the flexible support 306 byultrasonic welding, adhesive, or any other suitable joining technique.

Each access port 40 includes an axially opposed pair of gripping rims321, including a proximally extending gripping rim 321 defined on acompression ring 323 joined to the distal end of each access port 40. Aportion of the flexible support 306 is gripped between the respectivegripping rims 321 of each access port 40. The flexible support 306 has arespective receptacle groove 325 defined therein for receiving each ofthe gripping rims 321.

With reference now to FIG. 29, at least one of the access ports 40 caninclude a surgical port assembly that provides mechanical sealing forsurgical instruments to reduce loss of pressure during surgicalprocedures. The assembly includes a tubular surgical port body 402extending from an upper surface of the end cap, e.g., any of the endcaps described above, and defining an access channel 401 therethrough. Acap 404 is mounted to a proximal end of the surgical port body 402 andopens into the access channel 401 of the surgical port body 402, asshown in FIGS. 30 and 31. A main seal 406 has a base 407 that is fixedbetween the cap 404 and the surgical port body 402 to suspend the mainseal 406 across the access channel 401 as shown in FIG. 31 to providemechanical sealing against surgical instruments extending through theaccess channel 401. A duck bill seal 408 is included distal from themain seal 406 within the access channel 401. The duck bill seal 408includes a base 409 that is fixed between the cap 404 and the surgicalport body 402 and provides mechanical sealing against surgicalinstruments extending through the access channel 401 in addition to thesealing provided by main seal 406.

A seal guard 412 is seated in an unfixed manner between the cap 404 andthe main seal 406 within the access channel 401. The seal guard 412 isof a material that is more rigid that those of the main seal 406 and theduck bill seal 408 to provide protection for the main seal 406 and theduck bill seal 408 when instruments are inserted through access channel401, and to prevent inversion of the main seal 406 and/or the duck billseal 408, e.g., when surgical instruments are withdrawn from accesschannel 401.

With continued reference to FIG. 31, the seal guard 412 extends acrossthe access channel 401 and is configured to move relative to the cap 404and the surgical port body 402 to accommodate movement of surgicalinstruments extending through the access channel 401. The seal guard 412can move relative to the bases 407 and 407 of the main seal 406 and duckbill seal 408. This movement is accommodated by the seating of the base413 of the seal guard 412 about the inward rim 403 of cap 404 withinaccess channel 401. Since it is free to move relative to the cap 404 andthe surgical port body 402, the seal guard 412 can accommodate movementof instruments relative to surgical port body 402 and therefore improvesealing against the instruments by the main seal 406 and duckbill seal408 relative to the sealing that would be accomplished if the seal guard412 was rigidly mounted relative to the cap 404 and the surgical portbody 402.

As shown in FIGS. 32 and 33, the seal guard 412 defines eight evenlyspaced access slits 414 therethrough in a distal, frustoconical sectionof the seal guard 412. The access slits are spaced circumferentiallyabout the central aperture 215 of the seal guard 412 for passage ofsurgical instruments through the seal guard 412, accommodated by thedeflectable panels separated by the access slits 414. The access slits414 facilitate alignment of surgical instruments with openings throughthe main seal 406 and the duck bill seal 408 to reduce leakage ofpressurized gas through the main seal 406 and duck bill seal 408 duringsurgery.

The methods and systems of the present disclosure, as described aboveand shown in the drawings, provide for single incision/natural orificesurgical access with superior properties including minimally invasive,multiple port access with flexibility for relative movement of theaccess ports. While the apparatus and methods of the subject disclosurehave been shown and described with reference to preferred embodiments,those skilled in the art will readily appreciate that changes and/ormodifications may be made thereto without departing from the scope ofthe subject disclosure.

What is claimed is:
 1. An access device for surgical procedurescomprising: a multiport end cap including a plurality of separate accessports for accommodating introduction of individual surgical instrumentsinto a body of a patient, the access ports extending in a proximaldirection, the end cap including a distally extending seal ring; and abottom body having a distally extending tubular body with an accesschannel defined therethrough for accommodating surgical instruments fromthe access ports into the body of a patient, the bottom body including aplurality of circumferentially spaced apart teeth, wherein the seal ringof the end cap is received inside and seals against a proximal rim ofthe bottom body; wherein the end cap includes at least one flexible tabwith distal teeth thereon configured to engage and disengage the teethof the bottom body to selectively permit or prevent relative axialrotation of the multiport end cap.
 2. The access device as recited inclaim 1, wherein the teeth of each of the at least one flexible tabsextend radially inwardly, and wherein the teeth of the bottom bodyextend radially outward.
 3. The access device as recited in claim 1,wherein each of the at least one flexible tabs includes a proximallyextending manipulation member and a compliant hinge member between themanipulation member and the distal teeth of the flexible tab.
 4. Theaccess device as recited in claim 3, wherein there are twocircumferentially opposed flexible tabs configured so that squeezing themanipulation members together releases the teeth of the flexible tabs toallow rotation of the end cap relative to the bottom body.
 5. The accessdevice as recited in claim 1, further comprising an elastomeric sealring forming a seal between the seal ring of the end cap and theproximal rim of the bottom body to provide sealing even during relativerotation of the end cap and bottom body.
 6. The access device as recitedin claim 5, wherein the elastomeric seal is seated in a circumferentialchannel defined in at least one of the seal ring and the proximal rim.7. The access device as recited in claim 1, wherein the bottom bodyincludes an insufflation gas inlet in fluid communication with theaccess channel.
 8. The access device as recited in claim 7, wherein theinsufflation gas inlet is configured to receive a tube set with one ormore lumens.
 9. The access device as recited in claim 7, wherein theaccess ports are configured to form mechanical seals for insufflationgas for when instruments are inserted through the access ports and whenthere are no instruments inserted through the access ports.
 10. Theaccess device as recited in claim 1, wherein there are three accessports extending proximally from the end cap, evenly spacedcircumferentially about the end cap.
 11. The access device as recited inclaim 10, wherein each access port extends from a respective planarfacet of the end cap.
 12. The access device as recited in claim 11,wherein each access port extends normal from the respective facet of theend cap.
 13. The access device as recited in claim 11, wherein therespective facets meet at facet junctures, wherein the facet juncturesmeet each other at an apex of the end cap.
 14. The access device asrecited in claim 12, wherein each facet is angled at an angle a from acircumferential plane of the end cap.
 15. The access device as recitedin claim 14, wherein the angle a is larger than 0° and less than orequal to 60°.
 16. The access device as recited in claim 1, wherein thetubular body is configured for introduction through a body lumen orthrough a single incision formed in the wall of the body of a patient.17. The access device as recited in claim 1, wherein the tubular body isconfigured for trans-anal introduction.
 18. The access device as recitedin claim 1, wherein the at least one flexible tab is integral with theend cap.
 19. The access device as recited in claim 1, wherein the endcap is configured for complete 360° axial rotation relative to thebottom body.
 20. The access device as recited in claim 1, wherein thebottom body includes a latching surface proximal to the teeth thereof,and wherein the at least one flexible tab is configured to latch withthe latching surface even during relative axial rotation of the end capand the bottom body to prevent axial displacement of the end caprelative to the bottom body.
 21. The access device as recited in claim1, wherein the tubular body is mounted to a main ring portion of thebottom body, and wherein the tubular body is of a less rigid materialthan that of the main ring portion.
 22. The access device as recited inclaim 1, wherein the end cap includes a radially protruding stopper rimthat abuts a proximal most surface of bottom body.
 23. The access deviceas recited in claim 1, wherein at least one of the access ports includesa surgical port assembly comprising: a surgical port body extending froman upper surface of the end cap and defining an access channeltherethrough; a cap mounted to a proximal end of the surgical port bodyand opening into the access channel of the surgical port body; a mainseal having a base fixed between the cap and the surgical port body tosuspend the main seal across the access channel of the surgical portbody to provide mechanical sealing against surgical instrumentsextending through the access channel of the surgical port body; a duckbill seal distal from the main seal within the access channel of thesurgical port body, the duck bill seal including a base fixed betweenthe cap and the surgical port body to provide mechanical sealing againstsurgical instruments extending through the access channel of thesurgical port body; and a seal guard seated in an unfixed manner betweenthe cap and the main seal within the access channel of the surgical portbody, wherein the seal guard extends across the access channel of thesurgical port body and is configured to move relative to the cap and thesurgical port body to accommodate movement of surgical instrumentsextending through the access channel of the surgical port body, toprovide protection for the main seal and the duck bill seal, and toprevent inversion of the main seal and/or the duck bill seal.
 24. Theaccess device as recited in claim 23, wherein the seal guard defines afrustoconical section defined by a plurality of spaced apart deflectablepanels separated by a plurality of access slits through thefrustoconical section for passage of surgical instruments through theseal guard.